Haoyang Du - Dr. Theodore Schwartz - Week7

 This week I went to the OR on Monday and Thursday to watch surgeries. On Monday, I saw an endarterectomy on the left carotid artery. The surgeons opened up the left carotid artery of the patient and removed as much of the calcified plaque from the artery wall as they can. The srub tech kindly showed us the plaque samples from the patient. Some of those are already hardened while others being soft and gelatin like. All the plaques are at a decent size where they are blocking the blood flow in the artery. The process of opening up the left carotid artery is really interesting. After doing the incision and preparing the surgery site to expose the artery, the surgeons applied clamps on both sides of the plaque position of the artery to stop the blood flow. The surgeon told us that this clamp can only be on there for at max 45 mins, or the left hemisphere of the brain will start of suffer from the lack of fresh blood supply. To mitigate this lost of the blood supply, the surgeon asked the anesthesiologist to give patient drugs that will increase the blood pressure of the patient. In this case with a higher blood pressure, some of the blood from the right side of the brain will be pushed to the left side of the brain to compensate for some of the loss of the blood supply. Still, this decrease in blood supply cannot last longer than 45 mins. During the surgery, there is also a neurologist on the side monitoring the EEG of the patient in real time. My assumption is that if there is any abnormal signal detected in the EEG, that might indicates the brain has started to react to this lack of blood supply, which means the surgeons should stop early and restore the blood flow in the artery quickly. The blood flow restoration process of the artery is also interesting. As the artery blood has a high pressure, the surgeon will suture the artery for 90% and left a tiny opening on it to allow blood coming out to mitigate the pressure. Other wise, the blood will come in the sutured artery with a high pressure and damage the tissue. When removing the clamps, the surgeon hold a cup over the site of the opening to catch the blood that shoot out from that opening. 

I watched an Endoscopic removal of skull base tumor with fat graft in the OR on Wednesday. The biopsy returned that it was pituitary adenoma. One interesting feature is that Dr. Schwartz cut open the tumor itself to debullk it. It is clear that the tumor is not homogeneous that things flowed out from its inside after the cut while the outside of the tumor is firmer.